General cancer Flashcards
Cervical, vaginal, vulval cancer
- Aetiology
- Pre-cancer
- Cancer
- Screen
- Patient
- Aetiology: HPV
- Pre-cancer: CIS
- Cancer: squamous
- Screen: cervical smear (age 20-69)
- Patient: post coital bleed (cervical), black lesions - puritic
Endometrial
- Aetiology
- Pre-cancer
- Cancer
- Screen
- Patient
- Aetiology: oestrogen exposure
- Pre-cancer: dysplasia, atypia
- Cancer: adenocarcinoma
- Screen: no screen
- Patient: post menopausal bleed
Ovarian (epithelial one)
- Aetiology
- Pre-cancer
- Cancer
- Screen
- Patient
- Aetiology: ovulation (trauma to epithelial layer)
- Pre-cancer: (low malignant potential) dont biospy
- Cancer: epithelial ovarian cancer
- Screen: no screen
- Patient: presents late stage
- renal failure from hydroobstrucive ureter, SBO, ascitiies
Chorio carcinoma
- Aetiology
- Pre-cancer
- Cancer
- Screen
- Patient
- Aetiology: gestational trophoblastic disease
- Pre-cancer
- Cancer: chorio
- Screen: b-hcg on ocp
- Patient: hyperemesis gravidarum, hyperthyroid, size date discrepancys
Cervical cancer Screening Patient Aetiology Dx Tx Screen
Screen - age 20, then 1 year then if normal - 3 years past this. Until age 69
Pt: post-coital bleeding, or post menopausal bleed
(need exposure to sex - HPV vaccine)
Infection with HPV, dysplastic cells (CIN 1 LSIL), then cervix gets infected (carcinoma in situ - HSIL), then once it leaves endothelial layer - then have endo or ectocervical (can see it)
–> squamous cell carcinoma
–> biopsy
RF - sex, smoking
Tx: -any abnormalities of cervix
-local ablative therapy
(if endocervical) - cut out everything - cone biopsy
Grading/staging cervical cancer
CIN 1,2,3
1 - inner, 2 - middle, 3 - whole layer
Stage
1 - cervix (1a - micro, 1b - macro)
2a - upper 2/3rds vagina
2.b - out to sides
3a - lower 1/3rd
3b - out to sides
- a - adjacent metastasises
- b - distant mets
Smear - cervical
negative - repeat 3 years ( but if has been 5 years since, then have to do one then another one in 1 year).
Abnormal - colposcopy - positive on ecto biospy or endo cutage
- If positive endo - then need a biopsy (cone)
- If positive ecto - local ablation and cryotherapy
If not sure - atypical
–> q6 month pap ?
Treatment - cervical
ecto- local ablation
Endo - cone biospy
2a - local resection
or 2b or worse - debulking, chemo and radiation
Endometrial cancer
oestrogen exposure (>11)
- accumulative effect
- progesterone, inhibits effect of estrogen (so OCPs protective against endometrial cancer)
Reproductive age female - dysmenorhea
Post menopausal women - vaginal bleeding
Estrogen exposure - hyperplasia - adenocarcionma
Increased Risk Annovulation - lose protective effect (PCOS) -age matters -nulliparity -obese -early menarche, late menopause -HRT or tamoxifen
no screen, can biopsy
Tx: remove mass and remove signal (bilateral salpinoorphrectomy)
-radiation and chemo (higher stages)
Work up - post menopausal bleed
- Endometrial sampling or dilation and cuttage
- negative - vaginal atrophy - estrogen creams
- pre-cancer - hyperplasia - reproductive age –> give progesterone
- cancer - total abdominal hysterectomy and bilateral salpingectomy
Mets- TAH + BSD + rads, chemo
Ovarian cancer
-germ cell
Young teens
Germ cells (path - non malignant) - teenage girls, adenxal mass + weight gain, stage 1.
-dysgerminomas (seminomas) - sensitive to chemo, test LDH
Endometrial sinus - alpha feto protein
Teratoma - stroma ovarii
Choriocarcionma: b-hcg
dx - transvaginal US
Tx - unilateral salpinophrecotmy
Epithelial
cystadeno carcionma Serous mucinous endometriad brenners
Path - trauma - more ovulation -extremely malignant Pt: increases w age (post menopausal) -nulli/low parity -OCPs -decrease risk
Stage 3b - normally present
(asym) - peritoneal seeding - spread quickly
- renal failure, SBO, ascites
BRCA 1/2/HNPCC
no screen
1st - Transvaginal US
-CT scan - stage
-track - CA-125
Tx - total abdominal hysteretomy, bilaterla salpineoophrectomy
Paclitaxel
Special - BRCA 1/2
transv vag US
ca-125
Prophylaxic hysterecomy and salpngency at age 35
Stromal cell tumors
-Granulosa -theca - oestrogen
Sertoli leydig - testosterone
Adenexal mass work up
Trans vaginal US
Smooth small cyst without septations - simple cyst - physiologic
-STOP
Large cyst - not smooht, sepetations and loculated fluid
- complex cyst
- Biopsy
(age and symptoms - can tell what type - e.g young - germ cell, treat conservatory) (older - SBO, ascities - epithelial tumor - TAH + BSO - pacitaol.
Vaginal/vuval cancer
Vuval cancer
- SCC - black and itchy
- Melanoma - black and itchy
- Pagets - red lesion - itchy (good prognosis) - wide local resection
can invade (SCC and melenom) -vuvlectomy and lN dissection
Pt: puritis
-inspection - infection - not caner
biopsy - scc, melenoma, pagets
-can also get vaginal HPV related SCC cancer
